EP3345614A1 - Zusammensetzung mit alkalinphosphatase zur verwendung bei der behandlung von arthritiden - Google Patents

Zusammensetzung mit alkalinphosphatase zur verwendung bei der behandlung von arthritiden Download PDF

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Publication number
EP3345614A1
EP3345614A1 EP17150448.3A EP17150448A EP3345614A1 EP 3345614 A1 EP3345614 A1 EP 3345614A1 EP 17150448 A EP17150448 A EP 17150448A EP 3345614 A1 EP3345614 A1 EP 3345614A1
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EP
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Prior art keywords
composition
treatment
ectophosphatase
use according
arthritis
Prior art date
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EP17150448.3A
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English (en)
French (fr)
Inventor
Rudi Brands
Willem SEINEN
Carolina Frederika Maria MOLTHOFF
Gerrit Jansen
Ronald Sake OOSTING
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Amrif BV
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Amrif BV
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Priority to EP17150448.3A priority Critical patent/EP3345614A1/de
Priority to US16/469,542 priority patent/US11103562B2/en
Priority to JP2019537258A priority patent/JP2020503874A/ja
Priority to EP17825154.2A priority patent/EP3565581B1/de
Priority to RU2019124447A priority patent/RU2754854C2/ru
Priority to PCT/EP2017/082337 priority patent/WO2018127363A1/en
Priority to AU2017390680A priority patent/AU2017390680B2/en
Publication of EP3345614A1 publication Critical patent/EP3345614A1/de
Withdrawn legal-status Critical Current

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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00Medicinal preparations containing peptides
    • A61K38/16Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/43Enzymes; Proenzymes; Derivatives thereof
    • A61K38/46Hydrolases (3)
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K38/00Medicinal preparations containing peptides
    • A61K38/16Peptides having more than 20 amino acids; Gastrins; Somatostatins; Melanotropins; Derivatives thereof
    • A61K38/43Enzymes; Proenzymes; Derivatives thereof
    • A61K38/46Hydrolases (3)
    • A61K38/465Hydrolases (3) acting on ester bonds (3.1), e.g. lipases, ribonucleases
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K31/00Medicinal preparations containing organic active ingredients
    • A61K31/33Heterocyclic compounds
    • A61K31/395Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins
    • A61K31/495Heterocyclic compounds having nitrogen as a ring hetero atom, e.g. guanethidine or rifamycins having six-membered rings with two or more nitrogen atoms as the only ring heteroatoms, e.g. piperazine or tetrazines
    • A61K31/505Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim
    • A61K31/519Pyrimidines; Hydrogenated pyrimidines, e.g. trimethoprim ortho- or peri-condensed with heterocyclic rings
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/0012Galenical forms characterised by the site of application
    • A61K9/0019Injectable compositions; Intramuscular, intravenous, arterial, subcutaneous administration; Compositions to be administered through the skin in an invasive manner
    • A61K9/0029Parenteral nutrition; Parenteral nutrition compositions as drug carriers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61KPREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
    • A61K9/00Medicinal preparations characterised by special physical form
    • A61K9/0012Galenical forms characterised by the site of application
    • A61K9/0053Mouth and digestive tract, i.e. intraoral and peroral administration
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00Drugs for skeletal disorders
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61PSPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
    • A61P19/00Drugs for skeletal disorders
    • A61P19/02Drugs for skeletal disorders for joint disorders, e.g. arthritis, arthrosis
    • CCHEMISTRY; METALLURGY
    • C12BIOCHEMISTRY; BEER; SPIRITS; WINE; VINEGAR; MICROBIOLOGY; ENZYMOLOGY; MUTATION OR GENETIC ENGINEERING
    • C12YENZYMES
    • C12Y301/00Hydrolases acting on ester bonds (3.1)
    • C12Y301/03Phosphoric monoester hydrolases (3.1.3)
    • C12Y301/03001Alkaline phosphatase (3.1.3.1)

Definitions

  • Present invention relates to a composition for use in the treatment of arthritides (also designated herein as arthritis).
  • Arthritides are a group of over 100 varieties of inflammatory or degenerative diseases that damage joints, involving pain or stiffness of the musculoskeletal system. Arthritis is an inflammation of a joint or joints. The most common types are osteoarthritis and Rheumatoid Arthritis (RA), Gout, Ankylosing spondylitis, but also can be secondary to other diseases like Psoriatic arthritis, Systemic Lupus Erythematosus. Examples of arthritis (not of acute forms) include osteoarthritis, rheumatoid arthritis, and gouty arthritis. Acute forms are commonly caused by bacterial invasion.
  • RA is characterized by chronic inflammation in multiple joints, which develops into erosion of marginal bone and cartilage, juxta-articular bone loss, and a general reduction in bone mass.
  • inflammatory cells especially lymphocytes and macrophages, are crucial players in the pathogenesis of RA, and that cytokines, such as tumour necrosis factor ⁇ (TNF ⁇ ), interleukin 1 (IL-1), IL-6 and IL-8, are also involved.
  • TNF ⁇ tumour necrosis factor ⁇
  • IL-1 interleukin 1
  • IL-6 interleukin 6
  • IL-8 interleukin-8
  • RA manifests itself as a joint disease
  • the root cause of RA may originate systemic.
  • RA patients show increased levels of plasma levels IL-1, IL-6 and TNF ⁇ (during exacerbations or chronic disease manifestation) indicative for a pro-inflammatory state physiological condition.
  • RA Rheumatoid arthritis
  • MTX MTX
  • DMARDs disease-modifying anti-rheumatic drugs
  • MTX Methotrexate
  • a monotherapy with MTX is not often associated with sustained disease remissions.
  • a major drawback of MTX is the cytotoxicity and nephrotoxicity and the negative effects to patients that are treated for a long time period. Only 50% of patients stay on MTX after 5 years due to its toxicity.
  • Another disadvantage is that resistance to MTX is known to be induced and therefore MTX is often used in combination with other drugs.
  • TNF anti-tumour necrosis factor
  • Etanercept or Infliximab anti-tumour necrosis factor
  • TNF ⁇ blockers anti-tumour necrosis factor
  • Etanercept or Infliximab anti-tumour necrosis factor
  • TNF ⁇ blockers For these types of drugs it has been shown to reduce disease activity, to have rapid improvement in joint pain and swelling, and reduce joint damage in patients suffering from RA shown.
  • TNF ⁇ is an important cytokine that is involved in a number of pro-inflammatory effects and plays a major role in inflammatory diseases such as rheumatoid arthritis and is a key element in its pathogenesis.
  • Current anti- TNF ⁇ drugs are used to block TNF ⁇ and thereby reducing the inflammatory response and potentially prevent or alleviate joint damage.
  • Anti- TNF ⁇ drugs are used either as stand alone therapy or in combination therapy, with e.g. MTX.
  • TNF ⁇ blockers demonstrate several side effects.
  • One of the foremost effects is the break of immune tolerance towards the antibody drug due to the non-natural nature of these drugs. This leads to the formation of inactivating antibodies and makes the applied dosages less effective. As a consequence the patient does not respond any longer to the beneficial effects of the compound. Patients then are re-introduced to other pharmaceuticals, like corticosteroids, that have major adverse implications for patient-specific time periods. Also, the use of anti-TNF antibodies may lead to increased risk to serious infections, in particular tuberculosis.
  • a composition comprising at least one ectophosphatase and a pharmaceutically acceptable carrier for use in the treatment of a mammal suffering from arthritis.
  • Arthritis include for example osteoarthritis, rheumatoid arthritis (RA), and gouty arthritis.
  • RA rheumatoid arthritis
  • gouty arthritis An inaccurate systemic response of the innate immune system during pro-inflammatory insults results in further progression of disease. Consequently, attenuating these flare-up (exacerbation)- mediated systemic inflammatory responses (e.g. cytokine storms) may prove beneficial.
  • Alkaline phosphatase (AP) fulfils this function, and hence can be applied as a routine therapeutic compound.
  • AP is a potent mitigator to e.g. TNF ⁇ responses in inflammatory conditions and AP activity results in significant attenuation of cytokine storms, as has been demonstrated in preclinical and clinical studies, e.g. in patients undergoing major surgery. Specifically sharp reductions were observed for pro-inflammatory markers like TNF ⁇ , IL-6 and IL-8, whereas IL-10 plasma levels were not much affected. The latter suggests that the basic pro-inflammatory triggering event does not occur in e.g. macrophages and other white blood cells in the presence of sufficient AP levels and as a consequence no anti-inflammatory IL10 is produced. Furthermore, in contrast to the current anti RA-agents that target one of the major cytokine intermediates, AP is proposed to be a gate keeper in the innate immune defence system, and affects multiple cytokines.
  • Alkaline phosphatase a physiological effective and active endogenous protein in healthy conditions, does not have putative adverse effects like increased risk for infections and development of issues to tolerance or resistance. Given the fact that even at high endogenous levels of AP is safe to both mother and developing child as observed during pregnancy and well tolerated for prolonged time intervals, we envision that AP therapy may be of benefit towards advanced rheumatic patients.
  • Oxidative stress e.g. Ischemic injury-
  • Oxidative stress e.g. Ischemic injury-
  • mediated down stream effects may result in release of nucleotides like ATP, ADP and AMP from affected cells.
  • These normally intracellular residing moieties, involved in intracellular energy supply, are potent pro-inflammatory factors (inflammation triggering moieties, ITM) once they are in the extracellular environment.
  • ITM's are detoxified by the activity of ectophosphatases like AP, CD39 and CD73.
  • AP is proposed as single anti-inflammatory, and in this case a stand-alone effective, anti-RA agent or even in combination therapy with other agents.
  • the advantage of the latter approach will be that doses required of such other pharma-chemical or biological anti-RA compounds will be lower, thereby reducing the likeliness for induction of resistance or impact on tolerance.
  • the present invention relates to the composition, wherein arthritis is rheumatoid arthritis.
  • a mammal suffering from arthritis can be any vertebrate, such as a monkey, horse, cattle, rodent, human being, preferably a human being.
  • the present invention relates to the composition, wherein said at least one ectophosphatase is selected from the group consisting of alkaline phosphatase, CD39, and CD73.
  • the source of such ectophosphatase can be multiple; derived from native sources or recombinant technology by expression of ectophosphatases in one-cellular organisms, like yeast, or multicellular organisms like plants or animals.
  • the present invention relates to the composition, wherein said at least one ectophosphatase is a recombinant alkaline phosphatase.
  • the present invention relates to the composition, wherein said at least one ectophosphatase is a recombinant mammalian alkaline phosphatase, preferably a human alkaline phosphatase.
  • the phosphatase used in the composition of present invention is compatible with the foreseen therapeutic intervention that it is to support, e.g. the treatment of a human being using the composition of present invention comprising a recombinant human alkaline phosphatase.
  • other combinations may be used, for instance the treatment of a human being using the composition of present invention comprising a non-human native or non-human recombinant alternative alkaline phosphatase, like e.g. bovine intestinal derived alkaline phosphatases.
  • composition of present invention can be applied by either topical (e.g. oral, inhalation therapy) or parenteral administration, in a suitable formulation applicable for such routes of administration.
  • parenteral administration Only after parenteral administration AP can act directly to the target.
  • Most treatments of chronic inflammatory diseases like rheumatoid arthritis still require frequent and long-term administration, which utilizes conventional routes such as oral administration, intramuscular and intravenous injections, resulting in accumulation of drug outside the inflamed area and sometimes unwanted systemic side effects.
  • Targeting can be made more specific by for example using nano-formulated AP.
  • the present invention relates to the composition, wherein the composition further comprising nanoparticles, wherein said nanoparticles are comprised of a material selected from the group consisting of fullerene, liposome, gold, poly lactic-co-glycolic acid (PLGA) and poly L-lactic acid (PLA).
  • PLGA poly lactic-co-glycolic acid
  • PLA poly L-lactic acid
  • the present invention relates to the composition, wherein the nanoparticles are comprised of a material selected from the group consisting of fullerene, liposome, gold, poly lactic-co-glycolic acid (PLGA) and poly L-lactic acid (PLA).
  • the nanoparticles that can be used to encapsulate the composition of present invention is preferably comprised of gold, poly lactic-co-glycolic acid (PLGA) or poly L-lactic acid (PLA), more preferably PLGA or PLA, most preferably PLGA.
  • a suited AP is preferably a recombinant human AP that has a prolonged plasma residence time.
  • recombinant human AP may be positioned as a routine use alternative compound to the current agents applied in the treatment of RA.
  • non-human like (glyco-)proteins such as bovine AP that is applied in cardiac surgery for short-term use only.
  • Typical for glycoproteins with warranted prolonged plasma residence time is a fully complex glycosylated oligosaccharide chain.
  • Most of the potential sources for AP do not have sufficient complex sugar-chains attached and consequently demonstrate plasma residence times that are a fraction of the preferred therapeutics.
  • Albeit alternative non-human AP, like bovine AP has significant TNF ⁇ blocker activity even with these short residence times, it is assumed not to be very efficacious when used chronically.
  • vacation drug off-period drug use
  • these AP's are proposed here to act as "vacation drug”.
  • AP for temporary use application, as "vacation drug”, several sources of AP can be used. Sources that are identified and from which biological relevant AP activity was established include native and recombinant APs expressed in e.g. yeast-, plant-, moss- and mammalian-expression models.
  • the present invention relates to the composition, wherein said treatment comprises parenteral or oral administration of said composition.
  • the therapeutic intervention can be applied by either topical (e.g. oral, inhalation therapy) or parenteral administration, in suitable formulation applicable for such routes of administration.
  • the present invention relates to the composition, wherein said treatment comprises prophylaxis; or delay of onset; or attenuated progression of arthritis; or attenuation of the inflammatory response of a mammal suffering from arthritis. Therefore the composition of present invention can be used as prophylaxis to prevent or reduce the inflammatory response during pro-inflammatory insults which results in the attenuation of further progression of disease. AP may also be used therapeutically for the treatment of a mammal suffering from arthritis.
  • the present invention relates to the composition, wherein said treatment comprises attenuation of the inflammatory response of a mammal suffering from arthritis.
  • the attenuation of the inflammatory response can also comprise the treatment of exacerbations of the patient suffering from arthritis.
  • the present invention relates to the composition, wherein said at least one ectophosphatase is a tissue specific ectophosphatase and said treatment is a chronic arthritis disease treatment.
  • the present invention relates to the composition, wherein said at least one tissue specific ectophosphatase is selected from the group consisting of intestinal AP (IAP), placental ALP (PALP) and liver AP (LAP), preferably placental ALP (PALP).
  • IAP intestinal AP
  • POP placental ALP
  • LAP liver AP
  • POP placental ALP
  • TNSALP tissue non-specific alkaline phosphatase
  • IAP Intestinal-AP
  • Placental-ALP Placental-ALP
  • crown domain that encompasses a RGD-binding site for bone-type AP in the TNSALP isozymes lacks in the tissue specific IAP and PLAP.
  • this crown domain is a homing moiety for the TNSALP and so, this would explain that e.g. intestinal ALP, albeit relatively increased in RA patients may compensate in part for nucleotide toxicity but not for bone formation.
  • the placental ALP may be used in RA patients. The safety of prolonged application of placental AP is warranted, since elevated plasma levels during pregnancy up to 30 fold normal levels are apparent.
  • the intestinal AP-isoenzyme may also be used as it is very similar to placental type alkaline phosphatase, however we would propose to use rather placental over intestinal type due to its favourable plasma residence time of about 6-7 days, thereby being compatible with acceptable treatment regimes for chronic disease treatment.
  • the intestinal isoenzyme compared to the placental isoenzyme has short plasma residence time, making the intestinal enzyme ideal to be applied in specific acute therapeutic interventions, like major surgery where it combats ischemic injury mediated complications.
  • the present invention relates to the composition, wherein said at least one ectophosphatase is a tissue non specific ectophosphatase and said treatment is a non-chronic arthritis disease treatment.
  • the present invention relates to the composition, wherein said composition comprises a tissue specific ectophosphatase and a tissue non specific ectophosphatase.
  • the tissue specific alkaline phosphatase is selected from the group of intestinal AP (IAP), placental ALP (PALP) and liver AP (LAP), preferably IAP, more preferably PALP, or a combination thereof.
  • the present invention relates to the composition, wherein the composition further comprises disease-modifying anti-rheumatic drugs (DMARDS).
  • the composition of present invention further comprises methotrexate (MTX), a well known DMARDS.
  • MTX methotrexate
  • DMARDS a well known DMARDS.
  • Combination therapy with alkaline phosphatase will enable effective therapeutic regimes at lower doses of MTX when combination therapy is applied.
  • MTX applied at doses for anti-RA therapy results in the efflux of /release of intracellular nucleotides like ATP and ADP from cells and subsequently are converted into adenosine.
  • Adenosine has potent anti-inflammatory impact and de-activates activated white blood cells that are causal to RA pathology.
  • alkaline phosphatase thus will be synergistic to MTX therapy by enabling conversion into anti-inflammatory adenosine. Also nucleotides released from cells under oxidative stress like those in affected areas implicated with RA will be converted thereby generating an anti-inflammatory micro-environment in e.g. joints.
  • the present invention relates to the composition, wherein the composition is administered at least once a month, preferably at least two times a month, more preferably at least three times a month, even more preferably at least four times a month, and most preferably at least five times a month. Furthermore the present invention relates to the composition, wherein the composition is administered at least once weekly, more preferably 2 times a month, preferably at least 3 weekly, more preferably at least once every month, and most preferably in periods extending one month periods. Furthermore the composition of present invention can be administered at least once every 2 months, preferably at least once every 3 months, more preferably at least once every 4 months, and most preferably at least once every 5 months. The composition of present invention may be administered at least once a week.
  • Placental AP e.g. native placental AP or recombinant human alkaline phosphatase (hRESCAP)
  • hRESCAP recombinant human alkaline phosphatase
  • hRESCAP human alkaline phosphatase
  • RA right knee
  • contralateral left knee serves as a internal control (control knee).
  • the model allows various options for therapeutic interventions, either before intra-articular injections or during boosts injections with mESA.
  • Dosing of hRESCAP 700 U/kg, i.p.
  • rats received a dose of levamisole (50 mg/kg, s.c.).
  • arthritic rats received treatment with methotrexate (1 mg/kg, i.p.).
  • mice were sacrificed and knees were decalcified and processed for IHC analysis of synovial macrophage infiltration, including 2 rat macrophage antibodies; ED1 (homolog of human CD68) and ED2 (homolog of human CD163, a proposed marker for human M2 anti-inflammatory macrophages).
  • IHC analysis of ED1 and ED2 macrophages was performed in multiple quadrants of synovial tissue, as described by Chandruputla et al (BioMed Int, 2015 ).
  • Macrophage counting included synovial lining layer (SL 1-10) and synovial sublining layers (SL 1-20).

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EP17150448.3A 2017-01-05 2017-01-05 Zusammensetzung mit alkalinphosphatase zur verwendung bei der behandlung von arthritiden Withdrawn EP3345614A1 (de)

Priority Applications (7)

Application Number Priority Date Filing Date Title
EP17150448.3A EP3345614A1 (de) 2017-01-05 2017-01-05 Zusammensetzung mit alkalinphosphatase zur verwendung bei der behandlung von arthritiden
US16/469,542 US11103562B2 (en) 2017-01-05 2017-12-12 Composition comprising alkaline phosphatase for use in the treatment of arthritides
JP2019537258A JP2020503874A (ja) 2017-01-05 2017-12-12 関節炎の処置における使用のための、アルカリホスファターゼを含む組成物
EP17825154.2A EP3565581B1 (de) 2017-01-05 2017-12-12 Zusammensetzung mit alkalinphosphatase zur verwendung bei der behandlung von arthritiden
RU2019124447A RU2754854C2 (ru) 2017-01-05 2017-12-12 Композиция, содержащая щелочную фосфатазу, для применения при лечении артритов
PCT/EP2017/082337 WO2018127363A1 (en) 2017-01-05 2017-12-12 Composition comprising alkaline phosphatase for use in the treatment of arthritides
AU2017390680A AU2017390680B2 (en) 2017-01-05 2017-12-12 Composition comprising alkaline phosphatase for use in the treatment of arthritides

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Application Number Priority Date Filing Date Title
EP17150448.3A EP3345614A1 (de) 2017-01-05 2017-01-05 Zusammensetzung mit alkalinphosphatase zur verwendung bei der behandlung von arthritiden

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EP17825154.2A Active EP3565581B1 (de) 2017-01-05 2017-12-12 Zusammensetzung mit alkalinphosphatase zur verwendung bei der behandlung von arthritiden

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AU (1) AU2017390680B2 (de)
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EP3737750B1 (de) 2018-01-09 2024-06-05 Theriva Biologics, Inc. Alkalische phosphatasemittel zur behandlung von entwicklungsstörungen des nervensystems
WO2019183209A1 (en) 2018-03-20 2019-09-26 Synthetic Biologics, Inc. Alkaline phosphatase agents for treatment of radiation disorders
WO2019183208A1 (en) 2018-03-20 2019-09-26 Synthetic Biologics, Inc. Intestinal alkaline phosphatase formulations
CN113069558B (zh) * 2021-04-12 2021-12-31 中山大学 一种可用于类风湿性关节炎的诊疗一体化纳米探针的制备及应用

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KR101786862B1 (ko) 2011-07-04 2017-10-18 메소블라스트, 아이엔씨. 류마티즘성 질환을 치료 또는 예방하는 방법

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US20090232731A1 (en) * 2006-05-18 2009-09-17 Martin Funk Cationic Liposomal Preparations for the Treatment of Rheumatoid Arthritis
WO2008104200A1 (en) * 2007-03-01 2008-09-04 Gelato Corporation N.V. Use of apyrase for the treatment of a pathology resulting from endotoxin activity
US20110206654A1 (en) * 2008-08-29 2011-08-25 The General Hospital Corporation Methods of Modulating Gastrointestinal Tract Flora Levels with Alkaline Phosphatase
WO2015112017A1 (en) * 2014-01-24 2015-07-30 Am-Pharma B.V. Chimeric alkaline phosphatase-like proteins

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US20200121765A1 (en) 2020-04-23
JP2020503874A (ja) 2020-02-06
EP3565581B1 (de) 2021-11-10
AU2017390680B2 (en) 2024-04-18
RU2019124447A (ru) 2021-02-05
US11103562B2 (en) 2021-08-31
AU2017390680A1 (en) 2019-07-04
RU2019124447A3 (de) 2021-02-19
WO2018127363A1 (en) 2018-07-12
EP3565581A1 (de) 2019-11-13
RU2754854C2 (ru) 2021-09-08

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